Infective endocarditis presenting as bilateral ocular choroidal ischaemia and acute visual loss.

We present a challenging case of infective endocarditis (IE) diagnosed after visual loss from bilateral ocular choroidal infarction in the absence of retinal vasculitis, typical retinal embolic phenomenon, clinical cardiac features or obvious medical history.Our case illustrates the difficulties in diagnosing IE and a high index of clinical suspicion is needed.

Inpatient versus outpatient diagnosis of heart failure across the spectrum of ejection fraction: a population cohort study.

Background: Early heart failure (HF) diagnosis is crucial to ensure that optimal guideline-directed medical therapy (GDMT) is administered to reduce morbidity and mortality. Limited access to echocardiography could lead to a later diagnosis for patients, for example, during an HF hospitalisation (hHF). This study aimed to compare the incidence and outcomes of inpatient versus outpatient diagnosis of HF.

Risk stratification and exercise recommendations in cardiomyopathies and channelopathies: a practical guide for the multidisciplinary team.

Exercise offers a plethora of health benefits. However, certain genetic and acquired diseases such as cardiomyopathies and channelopathies are associated with sudden cardiac death during exercise. Several factors complicate exercise prescription in individuals living with these conditions.

Qualitative evaluation of the Rehabilitation Exercise and psycholoGical support After COVID-19 InfectioN (REGAIN) randomised controlled trial (RCT): 'you are not alone'.

Background: This qualitative evaluation was embedded in the Rehabilitation Exercise and psycholoGical support After COVID-19 InfectioN (REGAIN) study, a randomised controlled trial (RCT) for those with post-COVID-19 condition ('long COVID') after hospital admission for COVID-19, comparing weekly home-based, live online supervised group exercise and psychological support sessions with 'best practice usual care' (a single session of advice).

Objective: To increase our understanding of how and why the REGAIN programme might have worked and what helped or hindered this intervention.

Design: A qualitative evaluation which utilised interviews with participants and practitioners delivering the intervention.

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial.

Objective: To investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.

Design: A feasibility randomised controlled trial with a parallel process evaluation.

Setting: Acute Stroke Unit and participants' homes (London, UK).

Developing a set of key principles for care planning within older adult care homes: study protocol for a modified Delphi survey.

Background: Older adult care homes in England are required to develop care plans on behalf of each of their residents and to make these documents available to those who provide care. However, there is a lack of formal agreement around the key principles that should inform the development of care plans in care homes for older adults. Using a modified Delphi survey, we intend to generate consensus on a set of key principles that should inform the care planning process.

How does the first index mode of birth in public or private hospitals predict subsequent births? A 16-year Australian population-based linked data study.

Objectives: In this descriptive study, we aimed to assess how the index mode of birth and subsequent birth modes vary over time for public and private hospital maternity care funding models. The second aim was to determine to what extent the index mode of birth predicts subsequent birth modes in general and whether this differs in public versus private hospital maternity care funding models. With our aim, we have an innovative approach, specifically the women's life course approach, which is hypothesis-generating and can be assessed in future studies.

Prevalence of musculoskeletal disorders among garment workers: a systematic review and meta-analysis.

Background: Garment workers are at high risk of musculoskeletal disorders (MSDs) due to repetitive physical tasks, long working hours and varying workstations. As there is no existing epidemiological overview of MSDs among garment workers, this systematic review aimed to evaluate the global evidence on prevalence of MSDs in this population.

Methods: A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Acceptability and feasibility of shared medical appointments to support self-management of anxiety and depression in primary care in England: a qualitative study of service user/patient perspectives.

Objective: Shared medical appointments (SMAs) are an innovative care delivery method that provides delivery of clinical care while also supporting self-management. Their usefulness for mental health conditions has only briefly been explored, though early evidence demonstrates their utility for supporting mental health management. Therefore, this study set out to better understand the views that adults with anxiety and depression have towards SMAs as a way of receiving care to support self-management in primary care.

Multicentre adaptive randomised trial of GvHD prophylaxis following unrelated donor stem cell transplantation comparing Thymoglobulin versus calcineurin inhibitor-based or sirolimus-based post-transplant cyclophosphamide (Methods of T cell Depletion, MoTD trial).

Introduction: Graft-versus-host disease (GvHD) remains a major complication of allogeneic stem cell transplantation (allo-SCT), affecting 30-70% of patients (representing 800 new patients per year in the UK). The risk is higher in patients undergoing unrelated allo-SCT. About 1 in 10 patients die as a result of GvHD or through complications of its treatment.

Assessing the feasibility of measuring residents' quality of life in English care homes and the construct validity and internal consistency of measures completed by staff proxy: a cross-sectional study.

Objectives: To assess the feasibility of capturing older care home residents' quality of life (QoL) in digital social care records and the construct validity (hypothesis testing) and internal consistency (Cronbach's alpha) of four QoL measures.

Design: Cross-sectional data collected in wave 1 of the DACHA (eveloping resources nd minimum dataset for are omes' doption) study, a mixed-methods pilot of a prototype minimum dataset (MDS).

Setting: Care homes (with or without nursing) registered to provide care for older adults (>65 years) and/or those living with dementia.

The Protocol for the Multi-Ethnic, multi-centre raNdomised controlled trial of a low-energy Diet for improving functional status in heart failure with Preserved ejection fraction (AMEND Preserved).

Introduction: Heart failure with preserved ejection fraction (HFpEF) is characterised by severe exercise intolerance, particularly in those living with obesity. Low-energy meal-replacement plans (MRPs) have shown significant weight loss and potential cardiac remodelling benefits. This pragmatic randomised trial aims to evaluate the efficacy of MRP-directed weight loss on exercise intolerance, symptoms, quality of life and cardiovascular remodelling in a multiethnic cohort with obesity and HFpEF.

Analytical approaches to evaluate risk factors of multimorbidity: a systematic scoping review protocol.

Introduction: Understanding causal risk factors that contribute to the development of multimorbidity is essential for designing and targeting effective preventive strategies. Despite a large body of research in this field, there has been little critical discussion about the appropriateness of the various analytical approaches used. This proposed scoping review aims to summarise and appraise the analytical approaches used in the published literature that evaluated risk factors of multimorbidity and to provide guidance for researchers conducting analyses in this field.

Differential attainment at national selection for higher surgical training: a retrospective cohort study.

Objectives: National selection for higher surgical specialty training (HST) in the UK is a high-stakes gatekeeping assessment. If barriers, such as differential attainment, exist at HST selection for some groups and not others, then this will have a significant and lasting impact on trainees' career progression and the diversity of the workforce, which should reflect the population it provides care for. The objective of this study was to characterise the relationship between candidate sociodemographic factors and performance at National Selection for HST in the UK.

Improving the diagnostic accuracy of referrals for papilloedema (DIPP) study: protocol for a mixed-methods study.

Introduction: Papilloedema can be the first sign of life-threatening disease, for example, brain tumours. Due to the potential seriousness of this clinical sign, the detection of papilloedema would normally prompt urgent hospital referral for further investigation. The problem is that many benign structural variations of optic nerve anatomy can be mistaken for papilloedema, so-called pseudopapilloedema.

Starfield's 4Cs of NCD management in primary healthcare: a conceptual framework development from a case study of 19 countries.

Introduction: Faced with a backdrop of an increasing chronic disease burden from an ageing global population compounded with rising healthcare costs, health systems are required to implement cost-effective, safe and equitable care through efficient service delivery models. One approach to achieving this is through Starfield's 4Cs of primary healthcare (PHC), which delineates the key attributes of a high-performing PHC system that upholds the pillars of care coordination, first contact of care, continuity of care and comprehensive care. Therefore, this study aims to explore and elucidate the key themes and subthemes related to and extending beyond Starfield's 4Cs of PHC by integrating findings from a comprehensive literature review and a qualitative study.

Preexisting multimorbidity predicts greater mortality risks related to long-term PM exposure.

Long-term health risk assessments related to ambient fine particulate matter (PM) exposure have been more limited to general population but not towards individuals suffering from multimorbidity. While both multimorbidity and PM are independently linked to elevated mortality risk, their combined effects and interactions remain practically unexplored. A cross-cohort analysis was undertaken on data from 3 prospective cohorts, initially enrolling 869038 adults aged ≥18 years followed up during 2005-2022.

Geographic heterogeneity of polycyclic aromatic hydrocarbons in Yangtze River sediments: Evidence from the longest river in Asia.

This work is the first comprehensive survey of the Yangtze River, covering its origin to the estuary mouth. It focuses on the geographical and industrial factors influencing the distribution of polycyclic aromatic hydrocarbons (PAHs) in sediments, along with their contamination levels, sources, and ecological risks. The total concentrations of PAHs ranged from 2.

Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report.

Background: The 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN) anaphylaxis criteria are widely used in clinical care and research. In 2020, the World Allergy Organization (WAO) published modified criteria that have not been uniformly adopted. Different criteria contribute to inconsistent care and research outcomes.

TOS UK (Thoracic Outlet Syndrome, United Kingdom): A Retrospective Review of Practice.

Objective: Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular bundle at the thoracic outlet which often poses a diagnostic challenge. Patient management is often based on surgeon choice and experience. This study aims to describe practices relating to the diagnosis and management of TOS in the UK over a 1-year period.

A UK value set for the WAItE.

Objectives: The Weight-Specific Adolescent Instrument for Economic Evaluation (WAItE) is a weight-specific patient reported outcome measure for use in adolescence, consisting of seven domains, each with five response levels. The objective of this study was to generate a UK value set for the WAItE, enabling the calculation of utility values.

Methods: An online Discrete Choice Experiment (DCE) completed by an adult sample representative to the working population of the UK was used to estimate the preferences for the five levels of the seven domains.

A Comparison of the Performance of Six Surrogacy Models, Including Weighted Linear Regression, Meta-regression, and Bivariate Meta-Analysis.

Objectives: Several trial-level surrogate methods have been proposed in the literature. However, often only one method is presented in practice. By plotting trial-level associations between surrogate and final outcomes with prediction intervals and by presenting results from cross-validation procedures, this research demonstrates the value of comparing a range of model predictions.

Screening for Type 2 Diabetes Mellitus: A Systematic Review of Recent Economic Evaluations.

Objectives: To examine recent economic evaluations, whether any type 2 diabetes mellitus (T2DM) screening designs may represent better value for money, and to rate their methodological qualities.

Methods: We systematically searched three concepts (economic evaluations (EEs), T2DM, screening) in three databases (Medline, Embase, and EconLit) for EEs published between 2010 and 2023. Two independent reviewers screened for and rated their methodological quality (using CHEC-Extended).

Rare Disease Policy in High-Income Countries: An Overview of Achievements, Challenges, and Solutions.

Objectives: To provide an overview of policy initiatives in high-income countries aimed at supporting the development and accessibility of treatments for rare diseases.

Methods: We examine how legislative, research, and pricing policies in high-income countries address barriers that have historically hindered innovation and access to rare disease treatments. By analysing examples from the EU, UK, US, Canada, Japan, and Australia, the article identifies ongoing initiatives, outlines current challenges, and explores proposed solutions to foster a sustainable, innovative, and accessible rare disease treatment ecosystem.

Social Return on Investment analysis: A Mixed Methods Approach to Assessing the Value of Adult Hospice Services.

Objectives Hospice services offer invaluable support to individuals facing life-limiting illnesses, however, quantifying their positive impact presents a challenge. As the demand for palliative care rises due to complex illnesses and an aging population, hospices face the need to prove their value. With funding primarily reliant on charitable donations and limited statutory support, they must demonstrate their effectiveness to secure additional resources in a competitive landscape.